Individual
GREGORY M. KOUFACOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., LCADC
Contact information
Practice address
32 RECTOR PL, BLOOMFIELD, NJ 07003-4031
(973) 615-4308
Mailing address
32 RECTOR PL, BLOOMFIELD, NJ 07003-4031
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37LC00165100
NJ
Other
Enumeration date
12/10/2010
Last updated
12/10/2010
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